Causes of stooped posture

November 14, 2012

DEAR DRS. DONOHUE AND ROACH: Help, help, help. I'm getting stooped, I hate it, and I hope you can tell what I can do to keep it from getting worse. Will exercise help? - S.M.

ANSWER: There are two common reasons for a stooped posture, and both of them need early evaluation.

The more common is osteoporosis. Although the stoop is sometimes called a "widow's hump" or a "dowager's hump," it can occur in men. It usually appears at an older age than in women, since men have, on average, a higher bone density than women do and women have a rapid loss of bone density after menopause. Osteoporosis is the loss of calcium from the bone, which weakens the bones and makes them more susceptible to fracture. Fractures in the bones of the neck tend to make the neck protrude forward, causing a characteristic stooped posture. This abnormality of the spine, called kyphosis, can happen in other parts of the spine as well, and can cause severe loss of height, and even an inability for the lungs to expand properly.

There is effective treatment for osteoporosis, and treatment can prevent fractures. Once fractures have occurred, however, it becomes very difficult to change the shape of the spine, which is why I recommend screening for osteoporosis before fractures occur. If you have any kind of change in your spine or neck shape and haven't been examined for osteoporosis (usually by an X-ray test called a DEXA), you should do so right away.

The second cause of stooped posture, which also occurs in both men and women, is spinal stenosis. Spinal stenosis is a condition where the nerves coming off the spinal cord are compressed. It may be a result of arthritis, bone disease or injury. Spinal stenosis almost always is associated with pain, numbness or weakness, usually of the back and legs. Many people with spinal stenosis find that they need to stop and rest after walking a short while, but report that if walking while pushing a shopping cart, they can walk as far as they want. The stooped-forward posture relieves pressure on the nerves and prevents the pain, numbness or weakness associated with the condition. This "shopping cart test" also helps distinguish spinal stenosis from similar leg pain caused by poor blood circulation. Treatment for spinal stenosis depends on its underlying cause and severity, and may include medication, physical therapy or, in severe cases, surgery.

DEAR DRS. DONOHUE AND ROACH: I was recently diagnosed with trigger finger. What is the cause, and is it a form of arthritis or carpal tunnel? Is hand exercise beneficial, or is it better to let it rest? - C.L.

ANSWER: Trigger finger is when the tendon to the finger gets stuck in its sheath. Tendons, which attach muscle to bone, travel in the finger in a sheath, which protects and lubricates the tendon. Sometimes, the sheath can become inflamed and the tendon sticks there - this leaves your finger in a bent position, sometimes painfully.

It is not related to carpal tunnel or arthritis. This is one instance where exercise does not help; in fact, it helps to rest the hand. Your doctor may have you wear a splint to really rest the finger. The doctor (usually an orthopedic surgeon) also may inject the finger with a steroid anti-inflammatory, though this may take several times to work. Surgery for this is uncommon.